09100215 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22001 LINDY LN CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100215
OWNER'S NAME: TOM&HEMAL SURRETTE DATE ISSUED: 10/29/2009
"NER'S PHONE: 4089969510 PHONE NO:
LJ LICENSED CONTRACTOR'S
/DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB F-
License Class 1 1,7 Lic.#
y "/ �"�,� � MECH RESIDENTIAL COMMERCIAL
Contractor /(/1/ l C/(JSjYI(J��jC aJ Date Z
I hereby arm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SWIMMING POOL DEMO
affirm
(commencing with Section 7000)of Division 3 of the Business&Professions *SEE NOTES
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35627002.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply /,�2�
with all non-point ounce gulations per the Cupertino Municipal Code,Section Issued by: Dater'
9.18. ��,�� L/ �<
Signature Date "o
/
( l RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Owner au rued agent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
g. ag of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35627002 . 00
DATE ISSUED. . . . . . . : 10/29/2009
RECEIPT #. . . . . . . . . : BS000009083
REFERENCE ID # . . . : 09100215
SITE ADDRESS . . . . . : 22001 LINDY LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : TOM & HEMAL SURRETTE
ADDRESS . . . . . . . . . . : 22001 LINDY LN
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4836
RECEIVED FROM . . . . : KN CONSTRUCTION INC
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 8, 000. 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 8, 000. 00 0 .80 0 .00 0 . 80 0 . 00
1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 0 . 00
1DEMOPRE SQUARE FEET 0. 00 490 . 00 0 . 00 490 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 605 . 80 0 . 00 605 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 605 . 80 #5050
---------------
TOTAL RECEIPT 605 .80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
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CITY OF CUPERTINO � /5
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CUPEkTINO PERMIT APPLICATION FORM
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APN# 3J ` 7- 00 Z_o O Date: x Q
Building Address:
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Mailing Address (if different from building address):
Owner's Name: Phone:
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Contractor: Phone : C j�) 4V „> l
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Contractor License #:
Cupertino Business License
Contact: Phone: v \ 3,7 4T(t 06—
lrl rp Fax:
Residential - Sq Footage Commercial ❑ Sq Footage
Job Description:
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Valuation: dcz)
Project Size: Express O Standard ❑ Large ❑ Major❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
1DEMOPRES Pool Demo Residential B 1SFP00L-DEM_
1BCBSC Cal Bldg Standards B ALL PERMIT
Commission Fee TYPES
1BSEISMICRE Seismic Residential B
Revised 01/07/09
a r s n
• „ C Y
ENTER
rROJECT
NAME
6 4
v 4 ¢
4.Use Solid Wall Systems(Includes SIPS,ICFs,&Any Non-Stick Frame Assembly)
a.Floors 70� 2 2
b.Walls
2 2
c.Roots -2 2
S.Reduce Pollution Entering the Home from the Garage
a.Tightly Seal the Air Barrier between Garage and Living Area 0
4 b.Install Garage Exhaust Fan OR Build a Detached Garage _p
EN 6.Design Energy Heels on Trusses(75%of Attic Insulation Height at Outside Edge of Exterior Wall) 0 1
7.Design Roof Trusses to Accommodate Ductwork 0 1
r-----
6.Use Recycled-Content Steel Studs for 90%of Interior Wall Framing 0 1
9.Thermal Mass Walls:5111-Inch Drywall on All Interior Walls or Walls Weighing more than-40 lwcu.fL 0 1
{ 10.Install Overhangs and Gutters
I N a.Minimum 16-Inch Overhangs and Gutters 0 1
b.Minimum 24-Inch Overhangs and Gutters 0 1
Total Points Available In Structural Building Frame and Envelope=36 0
E.EXTERIOR FINISH Points Available Pet Measlile
1.Use Recycled-Content(No Virgin Plastic)or FSC-Certified Wood Decking 0 ; 2
2.Install a Rain Screen Wall System 0 2
--
3.Use Durable and Noncombustible Siding Materials 0 1
— 4.Select Durable and Noncombustible Roofing Materials 0 2
Total Points Available in Exterior Finish= 0
F.INSULATION Points.Rvaileble Eer`Measure
1.Install Insulation with 75%Recycled Content
3 a.Walls and/or Floors
■— b.Ceilings 0 1
2.Install Insulation that is Low-Emitting(Certified Section 01350)
t a.Walls and/or Floors 0 1
b.Ceilings 0 1
3,Inspect Quality of Insulation Installation before Applying Drywall 0 1
Total Points Available in Insulation=1 0
G.PLUMBING Points Available Per Measure-1 '
1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points)
a.Insulate Hol Water Pipes from Water Heater to Kitchen 0
b.Insulate M Hot Water Pipes
c.Use Engineered Parallel Piping 0 1
d.Use Engineered Parallel Piping with Demand Controlled Circulation Loop O-.. .__.........' -.__.._ ...__l._
i e.Use Structured Plumbing with Demand Controlled Circulation Loop `
i
I.Use Central Core Plumbing M it 1 1 2
2.Install Only High Efficiency Toilets(Dual-Flush orS1.26 gpf) 0 ! 4
Tolal Points Available In Plumbing=Total 1 0
H HEATING,VENTILATION&AIR CONDITIONING - Points.Available PerM6asurer.,'
1.Design and Install HVAC System to ACCA Manual J,D,and S Recommendations 0 4
k 2,Install Sealed Combustion Units
s
1 a.Fumaces 0 i 2
�.. b.Water Heaters 0 2
3.Install Zoned,Hydronic Radiant Heating with Slab Edge Insulation 0 1 i 1
4.Install High Efficiency Air Conditioning with Environmentally Responsible Refrigerants 0 1
5.Design and Install Effective Ductwork
fa.Install HVAC Unit and Ductwork within Conditioned Space 0 3 1
b.Use Duct Mastic on All Dud Joints and Seams 0 1
c.Install Ductwork under Attic Insulation(Buried Ducts) 0 1
d.Pressure Balance the Ductwork System 0 1
e.Protect Duds during Construction and Clean All Ducts before Occupancy 0 1
_ 6.Install High Efficiency HVAC Filter(MERV 6+) 0 1
■ 7.Don't Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Less Than 60% 0 f 1
U
sing CSA Standards j
5.Install Effective Exhaust Systems In Bathrooms and Kitchens
+ a.Install ENERGY STAR Bathroom Fans Vented to the Outside 0 1
f b.All Bathroom Fans Are on Timer or Humidistal 0 1
c.Install Kitchen Range Hood Vented to the Outside 0 r 1 1
9.Install Mechanical Ventilation System for Cooling(Maximum 4 Points)
a.Install ENERGY STAR Ceiling Fans b Light Kits in Living Areas 8 Bedrooms 0 1
b.Install Whole House Fan with Variable Speeds 0 1
®2007 Build It Green Single Family GreenPoint Cheddist 2007 Version Page 3 of 7
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEf�TINO
Building Department
JOB ADDRESS: Z PERMIT #
OWNER'S NAME: PHONE # 510 - YQ(e- 5'10
GENERAL CONTRACTOR FAX # log
I am not using any subcontractors: b Z.
Si tore 1 DatLf
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Til9/ z
Owner/Contractor Signature Dat